Insights

Payer strategies are evolving quickly, and healthcare organizations must be alert to make the most of revenue opportunities while mitigating claims denials. Ensure your organization is prepared with our whitepaper.

In light of recent denials and DRG downgrading by payers, how your organization adapts will profoundly affect your reimbursements. An organization’s own internal review can set the stage for monitoring and remediating any inappropriate downgrading of DRGs by the payer.

Will you overreact and implement strategies that can unnecessarily constrict your revenue or will you prepare by consolidating an optimal approach grounded in best practices? These questions must be asked because, based on our recent experience, facilities are vulnerable.

Understanding the basics of DRGs, clinical documentation queries, and the Recovery Audit Program helps put claim denials and DRG downgrading by payers in perspective and sets your organization on the road to reversing denials through improved DRG coding, education, and documentation and query processes.

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